Cuts to public health risks widening health inequalities

After taking on responsibility for public health, local authorities were dealt an in-year cut of £200 million last year and now face further real terms cuts to public health budgets. Cuts to public health and the front line services they deliver are a false economy as they not only add to the future costs of health and social care but risk widening health inequalities, says the Health Committee in its report on Public health post-2013.

Whole life course approach required

In her first speech as Prime Minister, Theresa May put reducing health inequalities at the top of her list for action, highlighting the 'burning injustice' that if you are poor you will die on average nine years earlier than if you are rich.

The government must recognise that tackling health inequalities and improving public health will not primarily happen in hospitals, even though hospitals receive the lion's share of health funding. Rather, it requires a whole life course approach, tackling the wider determinants of health in local communities, effective action on prevention and early intervention, and through joined-up policy making at a national level.

There is a growing mismatch between spending on public health and the significance attached to prevention in the NHS 5 Year Forward View.

Call for bold and brave action

To support this agenda at a national level, the Committee wants to see a Cabinet Office minister given specific responsibility for embedding health across all areas of Government policy at national level.

The report concludes that while there is evidence of progress locally, there is less evidence of such an approach becoming embedded across Government departments. It calls for the Government to take bold and brave action through its life chances and childhood obesity strategies in order to improve public health and reduce health inequalities.

Chair's comments

Health Committee Chair, Dr Sarah Wollaston adds:

"The disappointing watering down of the childhood obesity strategy, published in August, demonstrates the gap in joined-up evidence-based policy to improve health and wellbeing. Government must match the rhetoric on reducing health inequality with a resolve to take on big industry interests and will need to be prepared to go further if it is serious about achieving its stated aims."

Public health does not primarily take place in hospitals but within local communities and the committee heard general but not universal support for the move of public health to local authorities but also concerns about the resulting fragmentation of some services and issues that have arisen over the transition.

Government policy

The Committee urges the Government to make good on its commitment to health in all policies by enshrining health as a material consideration in planning and licensing law.

The Committee heard evidence that this would help local government to directly improve the health of their local communities and reduce health inequalities. Local authorities need the levers to be able to take effective action to protect local communities and this is especially important given the cuts to their budgets.

Public health system progress

The Committee found that in some local authorities good progress has been made, with modest positive impact on public health outcomes already being seen, but in others, less headway has been made. The new public health system is designed to be locally driven, and therefore a degree of variation between areas is to be expected. However, the Committee is concerned that robust systems to address unacceptable variation are not yet in place.

The current system of sector-led improvement needs to be more clearly linked to comparable, comprehensible and transparent information on local priorities and performance on public health. Changes to local government funding, especially the removal of ring-fencing of the public health grant, must be managed so as not to further disadvantage areas with high deprivation and poor health outcomes.

Health protection

Health protection—encompassing prevention, preparedness and response to outbreaks and other health threats—is a critical public health function. Despite several sets of guidance on responsibilities the Committee heard that confusion, duplication and lack of clarity persist in some local areas.

Public Health England must ensure that local areas are clear about their responsibilities and equipped to deliver a seamless and effective response to outbreaks and other health protection incidents.